Currently the Strachur Medical Practice is opted in to providing 24 hour medical cover 365 days a year. It is only one of two practices in the area that still carries this responsibility.
As I've mentioned before on the practice blog, this 24 hour responsibility is a huge burden. This is not in any way the fault of the patients in Strachur, who rarely call except in a genuine emergency. I think patients living in rural areas understand that the GP cannot always be immediately available. If a patient had a medical emergency, and called the surgery only to discover that I had gone to Glasgow shopping with my family, then I think they would understand. In the past, the doctor would leave word and would either see the patient on his/her return, or the patient would go to the hospital in Dunoon.
However, my contractual and professional obligation is to be immediately available within the practice area at all times for emergencies. We only have three calls per week in Strachur on average, yet I cannot take my children to Benmore gardens for a walk. A meal in the Loch Fyne Oyster bar is fraught with danger because of the poor mobile phone signal. What if someone dies because I was not able to be contacted?
If a patient were to complain, I would not face a sympathetic hearing. I would be judged by peers who have never worked in remote general practice or as singled handed GPs. Judged by their standards, a trip to the shops in Dunoon could easily lead to me losing my practice, having registration as a doctor taken away by the GMC, or being sued in court.
The Health Board currently pays the practice around £20,000 per year towards the costs of the on call. However, to get a locum doctor to cover the practice costs between £1000 and £1600 per weekend and £100-£200 per night. Were I to be incapacitated for a period of time, the cost of out of hours locum cover alone would be around £110,000 per year. Recently, a friend of mine (a single handed GP on one of the small islands) became very unwell and had to be admitted to hospital. Her Health Board helpfully told her that she was in breach of contract leaving the island and should not have allowed herself to be admitted to hospital until she had organised a locum doctor and waited for them to arrive on the island to take over from her.
Also, it is increasingly difficult to get locums who have any experience of this kind of out of hours. Recently, I have had locums who were worried because they have always worked in Out of Hours centers which had receptionists to answer the phones, nurses to help with patients, and a driver to drive them to visits at night and weekends.
So, reluctantly, I've decided to ask the Health Board to allow me to opt out of the responsibility for providing 24 hours medical cover.
I have submitted a bid from our limited company to continue to provide out of hours cover from Strachur with more locum doctors at the market rate of pay, and they are considering this option. It is expensive, and works out at around £400 to £600 per call.
I have also said that I will always be happy to respond to medical emergencies in the area when I am here even though it will no longer be part of my contract and I will not be receiving any payment for it. Dr Wright has said the same, as has Dr Tittmar. That is part of living in a rural community. If we are unavailable (or the call is not an emergency) then the Health Board will have an alternative system in place for patients to use.
Actually, I think this is the system that most people think we have at the present anyway.
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